REVIEW ARTICLE
Effects of Antioxidant-rich Indo-mediterranean Foods on Pre-heart Failure: Results from the Meta-analysis of Randomized Controlled Trials.

The role of different diets and nutrients in the pathogenesis of cardiac dysfunction is controversial. However, it is well known that the Western diet has pro-inflammatory systemic effects, whereas Mediterranean-style diets have anti-inflammatory effects in all body systems. This study aimed to examine the effects of functional foods, omega-3 fatty acids and flavonoid-rich diets in patients with a high risk of Cardiovascular Diseases (CVDs) with reference to Heart Failure (HF).

This meta-analysis included data from three randomized, controlled single-blind trials, published earlier, on the role of Indo-Mediterranean style foods and nutrients in the prevention of CVDs, including HF. The intervention and control groups were compared for behavioural risk factors, food intakes, fatty acid intake and on the ratio of Polyunsaturated Fatty Acid (PUFA)/flavonoid intake, respectively, in the two groups (n=1446 vs n=1320). The diagnostic criteria for Pre-Heart Failure (PHF) and HF were electrocardiographic abnormalities and radiological increase in the heart size.

Effects of Indo-Mediterranean style foods on parameters like PHF, HF, and cardiac arrhythmias were significantly lower in the intervention group as compared to the control group. At baseline, all parameters of HF showed no significant differences between intervention and control groups. However, after a follow up of two years, left ventricular strain (Odds Ratio 0.57,confidence interval 0.50-0.65, P<0.01), left ventricular hypertrophy (OD 0.69, CI 0.64-0.75, P<0.01), as well as, NYHA class II-IV HF(OR 0.59, CI 0.50-0.68,P<0.05) were significantly lower in the intervention group as compared to the control group. The incidence of cardiac arrhythmias was also significantly lower in the intervention group as compared to the control group (OR 0.49;CI 0.42-0.56,P<0.01). The intake of omega-3 fatty acids and flavonoids was significantly higher and the ratios of Omega-6/Omega-3 fatty acids, as well as PUFA/flavonoids were significantly lower in the intervention group A, compared to control group B, indicating that increased intake of omega-3 fatty acids and flavonoids may have provided beneficial effects in the electro-mechanical functions of the heart.

Our results suggest that adherence to the intake of Indo-Mediterranean style diets can markedly reduce the incidence of PHF and HF as well as cardiac arrhythmias. The cardioprotective effects of diets rich in flavonoids and long-chain omega-3fatty acids (PUFA) are most likely associated with their potent antioxidant and anti-inflammatory actions.